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Background and Aims Accidental dural punctures (ADP) during neuraxial analgesia/anesthesia pose significant concerns in obstetrics, prompting post-dural puncture headache (PDPH) in 50-88% of cases. Understanding the determinants of post-ADP length of stay (LOS) is crucial for optimizing care. This study aims to identify such determinants in parturients.

Methods This retrospective study included all patients diagnosed with ADP after neuraxial labor analgesia at our institution, between October 2013 and 2023. All relevant data were obtained from medical records’ review.

Results Seventy-four ADP were identified. The mean post-ADP LOS was 4.69 days, exceeding the average LOS for uncomplicated deliveries at our institution. Moderate-to-severe PDPH was associated with prolonged hospitalization (mean LOS: 4.91 vs 3.43 days, p<0.05). Interestingly, epidural blood patch (EBP) administration did not reduce the LOS. However, when headache onset occurred within 48 hours after ADP, early EBP (<48 hours after ADP) was linked to earlier discharge (mean LOS 3.5 vs 5.11 days, p<0.05). Premature birth, ASA classification and cesarean delivery were associated with extended hospitalization. These factors were not associated with PDPH development or severity. Age, BMI, and technical aspects related to neuraxial approach showed no association with LOS.

Conclusions PDPH-related factors, as headache intensity and early EBP in parturients displaying early symptoms, were associated with the hospitalization duration. Although there’s evidence in the literature that an early EBP may increase the need to repeat the procedure, our study didn’t demonstrate that. Determinants of obstetric post-ADP LOS are multifactorial and also depend on obstetric factors. Managing ADP-related hospital stays is complex and further research is needed.